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Favipiravir in Hospitalized COVID-19 Patients (FIC)

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ClinicalTrials.gov Identifier: NCT04359615
Recruitment Status : Not yet recruiting
First Posted : April 24, 2020
Last Update Posted : April 28, 2020
Sponsor:
Information provided by (Responsible Party):
Seyed Sina Naghibi Irvani, MD, MPH, MBA, Senior Researcher., Shahid Beheshti University of Medical Sciences

Brief Summary:
The present study is a randomized, double-blind, controlled, clinical trial, with the approval of the ethics committee will be conducted on patients who have a positive test confirming COVID-19 in Shahid Modarres Medical Education Center and Hospital in Tehran. Patients will be randomly assigned to the two arms of the study and after completing the course of treatment and collecting and analyzing the necessary information from each patient, the results of the study will be published both on this site and in the form of an article in a reputable international journal.

Condition or disease Intervention/treatment Phase
COVID-19 Drug: Favipiravir Drug: Hydroxychloroquine Phase 4

Detailed Description:

Favipiravir, previously known as T-705, is a prodrug of a purine nucleotide, favipiravir ribofuranosyl-5'-triphosphate. The active agent inhibits the RNA polymerase, halting viral replication. Most of favipiravir's preclinical data are derived from its influenza and Ebola activity; however, the agent also demonstrated broad activity against other RNA viruses. In vitro, the 50% effective concentration (EC50) of favipiravir against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 61.88 μM/L in Vero E6 cells.

Limited clinical experience has been reported supporting the use of favipiravir for COVID-19. In a prospective, randomized, multicenter study, favipiravir (n = 120) was compared with Arbidol (n = 120) for the treatment of moderate and severe COVID-19 infections. Differences in clinical recovery at day 7 were observed in patients with moderate infections (71.4% favipiravir and 55.9% Arbidol, P = .019). No significant differences were observed in the severe or severe and moderate (combined) arms.73 These data support further investigation with randomized clinical trials (RCTs) of the efficacy of favipiravir for the treatment of COVID-19.

Chloroquine has been a broadly-utilized anti-malaria agent which back in 2006, had been proved to be a powerful wide-spectrum antiviral. Moreover, Chloroquine has the characteristics of anti-inflammatory and immune-modulatory by inhibiting the production of tumor necrosis factor alpha (TNF-α) along with interleukin 6 (IL-6). In the first half of February, a study illustrated puissant inhibition of SARS-CoV-2 by Chloroquine, when taking two 500-mg tablets of it by mouth per day; similar to some clinical studies in China through this outbreak. According to the news briefing of a study, it was indicated that chloroquine phosphate actually outdo the control treatment in inhibition of pneumonia exacerbation, improving lung imaging findings, and curtailing the disease course. Another study evaluated the possible doses of chloroquine (CQ) and hydroxychloroquine (HCQ) to find the optimized dose in treatment of COVID-19. They revealed that while within in-vitro settings Hydroxychloroquine is more potent than chloroquine. As a conclusion, they suggested a 800 mg daily dose of hydroxychloroquine, followed by an overall maintenance dose of 400 mg per day divided in two separate doses, which was three-fold more potent compared to the 500 mg twice daily administration of chloroquine in 5 days. The new study published in 16th March, pointed out that hydroxychloroquine was notably effectual in eradicating SARS-CoV-2 from the nasopharynx. Currently the evidence is quite inconclusive about the effectiveness or comparative effectiveness of either HCQ or CQ. Moreover, CQ has recently become scarce and even unavailable for ordering due to a huge demand for it, all because of a significant interest gained as a potential medicinal alternative for the management of COVID-19. In spite of all, the primary experience in China and France is propitious for the potential role of chloroquine, or alternatively hydroxychloroquine, for managing COVID-19.

The present study is a randomized, double-blind, controlled, clinical trial, with the approval of the ethics committee will be conducted on patients who have a positive test confirming COVID-19 in Shahid Modarres Medical Education Center and Hospital in Tehran. Patients will be randomly assigned to the two arms of the study and after completing the course of treatment and collecting and analyzing the necessary information from each patient, the results of the study will be published both on this site and in the form of an article in a reputable international journal.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The present study is a randomized, double-blind, placebo-controlled, clinical trial, with the approval of the ethics committee will be conducted on patients who have a positive test confirming COVID-19 in Shahid Modarres Medical Education Center and Hospital in Tehran. Patients will be randomly assigned to the two arms of the study and after completing the course of treatment and collecting and analyzing the necessary information from each patient, the results of the study will be published both on this site and in the form of an article in a reputable international journal.
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of Favipiravir Compared to the Base Therapeutic Regiment in Moderate to Severe COVID-19: A Randomized, Controlled, Double-Blind, Clinical Trial
Estimated Study Start Date : April 20, 2020
Estimated Primary Completion Date : May 3, 2020
Estimated Study Completion Date : May 5, 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Favipiravir Drug: Favipiravir
This will be drug only used in the intervention arm of our study, designed mainly to assess the additional efficacy and safety of Favipiravir in COVID-19 patients.

Drug: Hydroxychloroquine
This Drug will be used in all arms as mandated by our governmental guidelines.

Active Comparator: Control Drug: Hydroxychloroquine
This Drug will be used in all arms as mandated by our governmental guidelines.




Primary Outcome Measures :
  1. Time to clinical improvement [ Time Frame: From date of randomization until 14 days later. ]
    Improvement of two points on a seven-category ordinal scale (recommended by the World Health Organization: Coronavirus disease (COVID-2019) R&D. Geneva: World Health Organization) or discharge from the hospital, whichever came first.


Secondary Outcome Measures :
  1. Mortality [ Time Frame: From date of randomization until 14 days later. ]
    If the patient dies, we have reached an outcome.

  2. oxygen saturation by pulse oximetry (SpO2) Improvement [ Time Frame: Days 1, 2, 3, 4, 5, 6, 7 and 14. ]
    Pulse-oxymetry

  3. Incidence of new mechanical ventilation use [ Time Frame: From date of randomization until 14 days later. ]
    Incidence of new mechanical ventilation use

  4. Duration of hospitalization [ Time Frame: From date of randomization until the date of hospital discharge or date of death from any cause, whichever came first, assessed up to 14 days. ]
    Duration of hospitalization (days)

  5. Cumulative incidence of serious adverse events [ Time Frame: Days 1, 2, 3, 4, 5, 6, 7 and 14. ]
    With incidence of any serious adverse effects, the outcome has happened.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age ≥ 18
  • COVID-19 Confirmed Cases (Reverse transcription polymerase chain reaction (RT-PCR) Confirmed).
  • Tympanic Temperature of ≥37.5 AND at least one of the following: Cough, Sputum production, nasal discharge, myalgia, headache or fatigue) on admission.
  • Time of onset of the symptoms should be acute ( Days ≤ 10).
  • SpO2 ≤ 93%
  • Respiratory Rate ≥ 22

Exclusion Criteria:

  • Refusal to participate expressed by patient or legally authorized representative if they are present.
  • Patients with prolonged QT or PR intervals, Second or Third Degree heart block and Arrhythmias.
  • Patients using drugs with potential interaction with Favipiravir or Hydroxychloroquine.
  • Pregnant or lactating women.
  • History of alcohol or drug addiction in the past 5 years.
  • Blood Alanine transaminase/aspartate aminotransferase (ALT/AST) levels > 5 times the upper limit of normal on laboratory results.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04359615


Contacts
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Contact: Seyed Sina Naghibi Irvani, MD, MPH, MBA +989141182825 sina.irvani@gmail.com

Locations
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Iran, Islamic Republic of
Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences and Health Services
Tehran, Iran, Islamic Republic of
Contact: Seyed Sina Naghibi Irvani, MD, MPH, MBA         
Sponsors and Collaborators
Shahid Beheshti University of Medical Sciences
Investigators
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Study Chair: Mohammad Fathi, MD Shahid Beheshti University of Medical Sciences
Study Director: Sasan Tavana, MD Shahid Beheshti University of Medical Sciences
Principal Investigator: Nasser Malekpour Alamdari, MD Shahid Beheshti University of Medical Sciences
Principal Investigator: Mehran Lack, MD Shahid Beheshti University of Medical Sciences
Principal Investigator: Nader Markazi, MD Shahid Beheshti University of Medical Sciences
Principal Investigator: Sanaz Zargar Balaye Jam, MD Shahid Beheshti University of Medical Sciences
Principal Investigator: Seyed Sina Naghibi Irvani, MD, MPH, MBA Shahid Beheshti University of Medical Sciences
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Responsible Party: Seyed Sina Naghibi Irvani, MD, MPH, MBA, Senior Researcher., Principal Investigator, Shahid Beheshti University of Medical Sciences
ClinicalTrials.gov Identifier: NCT04359615    
Other Study ID Numbers: Favipiravir in COVID-19
First Posted: April 24, 2020    Key Record Dates
Last Update Posted: April 28, 2020
Last Verified: April 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: There is no further information.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Seyed Sina Naghibi Irvani, MD, MPH, MBA, Senior Researcher., Shahid Beheshti University of Medical Sciences:
COVID-19
Hydroxychloroquine
Chloroquine
Favipiravir
Novel Coronavirus
SARS-CoV-2
Additional relevant MeSH terms:
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Hydroxychloroquine
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antirheumatic Agents